Abstract Objective To explore the clinical value of O-POSSUM score and Nottingham score in the elderly patients with hip fracture, so as to reduce perioperative complications.Methods From January 2015 to June 2019, the data of 228 cases of hip fractures were analyzed retrospectively. The incidence and mortality of postoperative complications were observed. The differences between the two scoring systems and related factors affecting postoperative complications were analyzed.Results ① The O-POSSUM score was 11.18 ± 2.92,The predicted complication rate was 11% - 93%, 86 cases (37.71%) were predicted,67 cases (29.38%) had complications, There was no significant difference between them (x2 = 3.551, P = 0.059).② The postoperative mortality was 3.07% (7 cases) and the actual mortality was 1.32% (3 cases). The difference was statistically significant (x2 = 5.341, P = 0.021).③ There was no significant difference in preoperative diagnosis, gender, anesthesia mode and O-POSSUM score in the complication group (P > 0.05).④ There were significant differences in Nottingham score, age, operation mode, anesthesia mode and intraoperative bleeding between the complication group and the non complication group (P < 0.001).Conclusion O-POSSUM score and Nottingham score could accurately predict the incidence of postoperative complications in the elderly patients with hip fracture, and provide help for the correct preoperative evaluation, However, the operator should still pay attention to the influence of operation mode, anesthesia mode, perioperative blood loss and other factors on the operation risk.